leading edge technology at walter reed army medical center - speaking notes

8/8/2019 Leading Edge Technology at Walter Reed Army Medical Center - Speaking Notes

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Cover: Page 1


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Mission: Page 2


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Legacy: Page 3


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One of the most interesting things about Walter Reed, and a major part of what makes us

world class, are our Centers of Excellence. These all began as congressional initiatives and

funded by congressional set asides, many of these are now funded out of our core budget. Id

like to highlight just a few.

CEN

TER FOR PROSTA

TE DISEA

SEProvides world class medical care and clinical research opportunities for all military beneficiaries with

prostate cancer. 8000 patient visits each year; a Tri-service database registry numbering 23,000

patients

.

CLINICAL BREAST CENTER PROJECT

A collaborative effort lead by Walter Reed Army Medical Center, including: Windber Medical

Center/Windber Research Institute, USU, and Henry M. Jackson Foundation.

Designated a Center of Excellence by the National Consortium of Breast Centers. We have a

tissue and serum/blood sample repository donated by patients; Biomedical informatics aswell as gene and protein research

GYNECOLOGIC CANCER TRANSLATIONAL RESEARCH CENTER

The only fellowship program in gynecologic oncology in the military and is widely recognized as one

of the top fellowship programs in the United States; Leading edge research in vaccine therapies for

ovarian and endometrial cancer

INTEGRATIVE CARDIAC HEALTH PROJECT

An optimal healing environment, ICHP integrates behavioral medicine with novel lifestyletherapies to support and stimulate healthy living. ICHP is the only center for translational

prevention research in the DoD.

I will discuss the 3D Applications center and the Complex Wound Initiative Program a bit later.

US MILITARY CANCER INSTITUTE

DIABETES INSTITUTE

DEPLOYMENT HEALTH CLINICAL CENTER

GASTROENTEROLOGYVACCINE HEALTH

DEFENSE AND VETERANS BRAIN INJURY CENTER

Centers: Page 6


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The Military Advanced Training Center is

considered the silver lining in the dark clouds of

the 2007 crisis.

Designed to return patients to the highest levels

of activity and to provide a place where research

can be done to share our advances in

rehabilitation and prosthetic design with allpatients who have sustained injuries resulting in

either amputation or functional limb loss.

981 Amputees have been treated in the MHS, 72%

of them here at Walter Reed. To date 147amputees have been returned to active duty - 47

currently in theatre in either Iraq orAfghanistan.

Many are in the Special Operations community

MATC: Page 7


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The Fire Arms Training System (FATS) is a

Wireless weapons simulator utilizing Bluetoothtechnology in more than 200 scenarios to allowindividuals to regain or improve skills by progressingfrom basic target practice to complex environmentactivities.

In existence for 5 years, FATS required for allpersonnel returning to active duty. Basicmarksmanship and shoot/no-shoot scenarios.

It incorporates all courses of fire for Army, Navy, AirForce and Marines.

As a part of this, there is a secondary Outdoor Field& Stream Program which incorporates hunting andfishing excursions in order to regain activities ofeveryday living

FATS: Page 8


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The ComputerAssisted Rehabilitation Environment is a

Helicopter simulator platform with force plates, cameras and a

treadmill embedded in Virtual reality environment. This is a great

example of the best of partnering between DoD and private industry.

Designed for patients with stability & balance problems, the

CAREN provides a safe, controlled environment where

patients can work on functional goals.

CAREN sessions are 30 minutes in length and may focus on:

Weight/Step Shifting

Walking/Running on

Obstacle Avoidance

Multitasking and Memory

Allows warriors to perform virtual activities in order tochallenge cognitive, neurologic and musculoskeletal

functioning.

Used for the full range of injuries including limb loss, TBI, PTSD

Since CAREN clinical rehabilitation sessions commenced in

January 2008, over 200 patients have been referred to the

CAREN by clinical providers completing more than 1250

sessions.

CAREN: Page 9


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GAIT Lab

On Par with the GAIT Lab at BAMC in San Antonio

and larger and more advanced than those at mostUniversity settings, our GAIT lab provides research

and provider/therapist and patient feedback for

clinical care decisions in the rehabilitation process and

usage of prosthetics with particular emphasis on

fitment and usage .

Most facilities have 12 cameras and 2 force plates

to detect and record movement. At Walter Reed we

incorporate 23 cameras , 6 force plates and an

additional instrumented treadmill which is not

commonly found in GAIT Lab facilities.

What we are able to do with our GAIT Lab is

equivalent, in many ways, to the motion capture

systems used by EA sports and Disney Pixar studios.

GAIT: Page 10


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The latest innovations in place for warriors are the power knee and the

X2, which provides significant comfort and ease of use for lower

extremity amputees.

Patients with upper extremity amputations receive 3 different types of limbs :

the myoelectric which runs off of electrodes that receive electronic feedback

from the body which tells the arm to move; the traditional body powered

limbs which are triggered by muscle action and a passive arm designed most

significantly for cosmetic purposes.

Along with the upper body prosthesis, patients receive several terminal

(hand mimicking) devices for various activities.

Contingent upon medical necessity and patient goals, it is not uncommon for

a warrior to leave our facility with a variety of activity specific prosthetic

devices including limbs designed for swimming, biking, running, golfing and

any number of specific functions to help them return to a rich, productive life.

In some cases which allow them to achieve certain goals and activities that

they had not attempted before their injuries.

The latest innovations ongoing at Walter reed includes our participation

as a clinical trials site in targeted muscle re-innervation.

Pioneered at the Rehabilitation Institute of Chicago, the latest advances in

smart prosthesis include the development of an arm which operates

effortlessly through feedback from multisite nodes which allow the arm to

move /act with the thoughts of the wearer.

The Bionic Man is no longer just an old 1970s TV show.

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There is always time to play games.

Gradually incorporated into treatment, Wii isnot a substitute for regular rehabilitation

programs, however we have begun using it as

an adjunct to regular therapy matched to

patients needs, deficits and goals.

The Wii allows patients to work on key areas

including standing and balance, prosthetic device

to eye coordination, positioning and

weight/strength building for prosthesis wearers

through games like boxing and tennis.

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Driving is one of the last great freedoms, and as Americans we lovethe open road. And this is important to our sense of self.

Vehicle simulation permits patients to relearn driving skills withadaptive equipment

Warriors use simulation that includes everyday obstacles in driving aswell as obstacles they might encounter in a combat environment.Simulator usage provides a form of de-sensitization.

This is a wonderful instance of our partnering with industry andother public entities to develop assistive technologies for thebenefit of our war fighters.

Funded by the Army Center for Enhanced Performance, the vehicle itselfwas donated by General Motors and modified for usage with assistancefrom students at Baltimore County community college.

Americas Army engineering developed the interactive 3-screendisplay and computer programming. Additionally we implementedadaptive controls and off road/on road scenarios with sound inorder to create controlled real life environments.

Real life sounds like the backfiring of a vehicle or the sounds of

screeching tires are incorporated in order to assist the simulator userwith assimilation into real world environments and help to decrease theurge to use tactical driving techniques so necessary in combat.

After mastering the simulator, war fighters are taken out in motorpool vehicles to practice what they have learned.

Driving: Page 13


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The 3D Medical Applications Center is One of a Kind Serving

all military medical facilities world wide, VA hospitals and

civilian organizations when complex procedures are being

planned for military beneficiaries

3DMedApps uses stereo lithography or solid imaging technology

along with the latest in computed tomography(CT)and magnetic

resonance imaging(MRI)to identify locations and conditions of the

patients bones and tissues.

Additionally, this leading edge technology offers surgeonsgreater opportunity to more effectively diagnose and plan

treatment for cancers and other tumor diseases. It is becoming

a standard in the treatment of heterotopic ossification.

Our staff creates extremely accurate 3Dmodels, identifying

anatomical positions and the conditions of bones and tissues. This

enables the surgical team to see and feel the patients simulated

anatomy as it will be experienced in the operating room.

3D MedApps also creates custom acrylic and, more recently,

titanium implants to serve as patients new body parts.

Titanium mesh has proven to be effective in cranial injuries

because the mesh enables tissue to grow into the titaniumnetwork and reduces problems with postoperative infection

3D: Page 15


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We do:

Bio-modeling

3D photographic modeling

Custom PMMA Implants

Custom Titanium Implants

Custom Titanium fixation

Digital custom anaplastology models

Our cutting edge models improve medical efficiency and patient outcomes byfacilitating pre-operative and treatment planning along with greater

cooperation among multiple medical disciplines enhancing provider education

and training.

This technology, fitting the implant into the defect like a piece of a jigsaw

puzzle has allowed many of these complex procedures to be done in less

time, in many cases what used to take 6 hours is now taking only 2.

They also enable physicians to counsel patients , explain treatment

options and foster greater patient understanding and consent of

treatment decisions.

In fact, we often create and give to patients miniature models of their injured

body parts to offer a more realistic , comprehensive viewpoint regarding their

injured bones look and how they will be repaired a critical step in the

warriors healing process.

3D Part II: Page 16


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Originally developed at the Uniformed ServicesUniversity of Health Sciences, the Da Vincirobot provides the most advanced technology in

use for OB/GYN and renal & prostate surgery.

With 3 dimensional viewing, 7 degree freedom ofmovement, magnification, motion scaling and tremorelimination, Da Vinci is a tool of both versatility andefficiency forWalter Reed surgeons.

The minimally invasive surgical fellowship wasinaugurated this years as a part of the GYNsurgical program with the goal of trainingenough surgeons to provide both traditionallaparoscopic and robotic surgeries at MTFsworldwide.

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Emergency bedside ultrasound is not new, infact

it is technology that has been around for

approximately 10 years. And The Army has

actually led the way and helped advance the

technology.

Equipment continues to get smaller, lighter and

more capable. With increasing utility and portability,

we are now able to bring the technology to thecombat zone.

Ultrasound: Page 18


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Electronic Medication Management AssistantPilot program at WRAMC began on 4/1/2009

So far 24 patients enrolled with 18 currently active

Affectionately known as EMMA, it is a medication dispensing machine initiallyapproved to assist TBI patients

However, there are now other populations at Walter Reed using the technologywhich include:

High risk/Sole provider patients

Non-compliant patients

Patients with Non-medical attendants.

Provides automatic reminders for patient to take medication on the EMMA itself and bytelephone and e-mail.

AWireless Modem transmits patient medication dispensing/usage information to providers

This is very different from the traditional method of sending patients home with prescriptionpill bottles.

Allows for providers to automatically make interventions based on how patientsdispense their medications.

Based on the successful results of pilot program at WRAMC, 3 additional sites

approved to test technology

Madigan Army Medical Center

The MEDDAC at Fort Carson

Womack Army Medical Center at Fort Bragg

Future of EMMA at WRAMC is secure as it has been approved for a 5 year 5 million dollarcontract which includes the 3 additional approved sites and the

Purchase of additional 12 EMMA machines for use by WRAMC patients

Enrollment capacity will increase from 18 to 30

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The Combat Wound Initiative Program (CWIP)

Is A multi-disciplinary, inter-service, private-public partnershipwhich advances definitive clinical care and research initiativesfor complex wounds sustained in combat and civilian trauma

as well as those resulting from chronic disease.

Targeted clinical and translational research incorporatesadvanced technology and treatment, tissue banking, andbioinformatics.

This is the best of translational medicine. We know there are

factors in the blood stream that are markers of inflammation,and determine the time of wound healing. What we want to dois actually manipulate the genes for these factors, andguarantee good wound healing and minimize the risk ofinfection

Additionally, We are working at the cellular level indermatology to produce weight bearing skin (acral skin)at the point of an amputees stump where it meets theprosthesis.. .thus minimizing wound breakdown andenhancing speed of recovery and rehabilitation.

CWIP: Page 20


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Therapeutic Hypothermia (at WRAMC + NNMC)Specifically focused on neurologic salvage in patients who have return ofspontaneous circulation after out of hospital cardiac arrest

Eosinophilic Esophagitis managementOne of only a handful of clinical centers nationally performing the allergen patch test insupport of treatment of eosinophilic esophagitis.

Bravo pH capsule,Used to determine the amount of acid that refluxes into the esophagus during a 24-hour study period. The capsule transmits a signal to a data recorder worn on thepatients belt. Only Walter Reed and Georgetown are currently doing this.

Third Eye Retroscope TechnologyDevice that delivers a continuous retrograde view of the colon . Disposable piece that ispassed through the instrument channel of a standard colonoscope. Allows us to look backand forward at the same time while doing colonoscopy.

Non- Mydriatic Digital Retinal CamerasUsed for diabetic retinopathy screening

ANSAR Autonomic Nervous System Monitoring DeviceMeasures both branches of the autonomic nervous system independently and simultaneouslyin real time.

Vestibular-Evoked Myogenic Potential (VEMP)VEMP testing is used to diagnose some uncommon disorders of balance. Surfaceelectrodes deliver sounds through the neck to the ears and the resulting brain

response is measured.

Off Axis Rotary Chair

Utilized to determine whether or not dizziness may be due to a disorder of inner ear or thebrain.

The future of medicine is truly now!

New Stuff: Page 21


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So what does the future

hold for us with the BRAC?

NMMC: Page 22


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Belvoir: Page 23

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Future Page 27


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Taking the best of 100+ years of

warrior care and so much morewe move to the future with the

creation ofWalter Reed-Bethesda, the National Military

Medical

Center and the newF

tBelvoir Community Hospital.And, as I always say, The UnifiedMedical Command will be born

from the healing pools and

gardens of Bethesda!!

Future: Page 27

leading edge technology at walter reed army medical center - speaking notes

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